Is Penile Doppler Ultrasonography Overdiagnosed?

AIM: The objective of this study was to determine whether penile Doppler ultrasonography (USG) examinations, combined with the administration of intracavernosal vasoactive agents, were correctly performed as a second-line diagnostic method with the proper indications in a select patient group. METHODS: A total of 200 patients who underwent penile Doppler ultrasounds in our clinic were included in the study. Patients' demographic data were collected, information about their medical-sexual history was taken, physical examinations were performed, and laboratory analyses were conducted. Patients were informed in detail about the process, and their consent was given prior to the study. Procedure outcomes and complications were also recorded. The relationship of vasculogenic pathologies was analysed, and the rate of abnormal results and complications was compared with the existing literature. RESULTS: Following the investigations, abnormal results were found in 24.5% of patients, while this rate was 6.8% in patients under the age of 40. Arterial insufficiency was found in 31 patients and venous insufficiency in 18 patients. Five patients had both pathologic conditions. No statistically significant correlation was found between arterial insufficiency and age, while venous insufficiency was significantly correlated with age (p=0.006). CONCLUSION: Penile Doppler ultrasounds should only be ordered for a carefully selected patient group. Ordering ultrasounds without a proper indication can result in unnecessary labour and financial loss, as well as an increase in invasive procedures.

Intraparenchymal hematoma as a late complication of retrograde intrarenal surgery

ABSTRACT A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.

Intraparenchymal hematoma as a late complication of retrograde intrarenal surgery.

A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.